Deprescribing: the emerging evidence for and the practice of the 'geriatrician's salute'

摘要

The process of a health professional withdrawing medicines for which the current risk may outweigh the benefit in the individual patient has been given a variety of names including the colloquial 'geriatrician's salute', 'de-intensification' and increasingly 'deprescribing'. The rise of deprescribing as a word with a definition, evidence base and implementation plan, reflects the changing environment in which we practice. In particular, the emphasis on evidence-based medicine and the need to care for our expanding ageing populations, which requires application of components of geriatric evaluation and management by a wider range of health care practitioners. However, there are still significant challenges related to research on the safety, efficacy and implementation of deprescribing. In this commentary, we discuss the current evidence on the effects of deprescribing, emergence of implementation tools to embed deprescribing into the clinical care of older adults, as well as efforts to develop guidelines to improve health care practitioners' awareness and self-efficacy of deprescribing. Ultimately, judicious prescribing and deprescribing, across a wide range of health care settings, ought to enable older people to use medicines to support their achievable ageing goals.